我国三级甲等医院麻醉专科护士岗位管理的现况研究

目的了解我国三级甲等医院麻醉专科护士岗位管理的现状。方法于2022年1月至2022年3月采用自制问卷及方便抽样法, 对我国大陆三级甲等医院麻醉专科护士岗位管理的现状进行横断面调查。结果发放问卷154份, 回收137份, 回收率89%, 剔除36份。本调查涉及我国25个省级行政区的101家三级甲等医院, 综合医院比率90%。83%的医院有单独的麻醉护理单元, 53%的医院麻醉专科护士比率≥10%, 94%的医院有专科护士岗位管理制度, 超过50%的医院具有专科护士的岗位职责、分层级管理制度、岗位待遇差异体现等, 低于50%的医院实施有聘期和专职的专科护士任职, 50%的医院符合麻醉专科护士服务的倡导范围。55%的医院开展了麻醉专科护士资格认证, 37%的医院为麻醉专科护士培训基地。96%的医院制订了麻醉专科护士的发展规划。结论目前我国三级甲等医院的麻醉专科护士岗位管理虽已初具雏形, 但其岗位管理的制度体系及专职化管理有待加强。     

北京地区腹膜透析中心护理工作现状调查

目的 了解北京地区腹膜透析中心护理工作现状,为改善现状和制定管理对策提供参考.方法 采用自行设计的腹膜透析中心护理工作情况问卷对北京地区开设腹膜透析中心的29所医院进行问卷调查.结果 29所医院中22所已设置腹膜透析专职护士岗位,共有腹膜透析专职护士54人,腹膜透析患者共2947例,护患比1∶10～1∶120,平均为1∶55.腹膜透析专职护士负责门诊患者腹膜透析相关护理操作、新患者培训、门诊随访等工作,其中24所医院的腹膜透析护士参与医院腹膜透析护理会诊,27所医院的腹膜透析护士参与科室质量管理,14所医院的腹膜透析中心承担护理教学任务,15所医院的腹膜透析中心承担护理科研任务.结论 北京市腹膜透析中心的护士配置,部分医院难以达到要求;腹膜透析专职护士越来越多地承担起专科护士的角色职能,腹膜透析护理逐渐向专科化发展.     

黑龙江省专科护士专职化岗位管理初探

目的建立一套适合黑龙江省专科护士的专职化岗位管理体系。方法采用德尔菲法对30名护理专家进行两轮问卷函询。结果两轮问卷的有效回收率均为100％,专家权威程度系数为0．88。初步形成了专科护士的专职化岗位管理体系,包括专科护士的任职资格、岗位职责、岗位培训和绩效考核。结论专家对专科护士专职化岗位管理的认可度较高,意见相对集中,函询结果可以为专科护士专职化岗位管理的实践提供理论基础。     

黑龙江省专科护士专职化岗位管理初探

目的建立一套适合黑龙江省专科护士的专职化岗位管理体系。方法采用德尔菲法对30名护理专家进行两轮问卷函询。结果两轮问卷的有效回收率均为100%,专家权威程度系数为0.88。初步形成了专科护士的专职化岗位管理体系,包括专科护士的任职资格、岗位职责、岗位培训和绩效考核。结论专家对专科护士专职化岗位管理的认可度较高,意见相对集中,函询结果可以为专科护士专职化岗位管理的实践提供理论基础。     

基于胜任力的专科护士选拔和管理

目的探讨临床专科护士的选拔和管理方法,为合理选拔和使用专科护士提供参考。方法医院设立专科护士岗位,通过确立专科护士任职资格,以竞聘方式选拔专科护士,签订岗位职责,加强专科护士岗位管理,使专科护士在临床一线发挥最大作用。结果 2008年以来,护理部设定21个专科护理岗位,共聘任专科护士56名,具有7个专科护理实训基地,为上海市培养450余名专科护士,具有3个专科护理门诊,年门诊量约2万人次,专科护士申请各级各类课题40余项、发表学术论文300余篇。结论基于胜任力的专科护士选拔和使用,使专科护理实训基地建设、专科护理门诊发展、护理科研等方面取得了较好的成效,有效地推动了医院专科护理的发展。     

麻醉科专科护士岗位胜任力评价指标体系的构建

目的 构建适合我国的麻醉科专科护士岗位胜任力评价指标体系,为麻醉科专科护士培养及评价提供参考.方法 通过文献回顾法、小组讨论法、德尔菲专家函询法以及层次分析法,确定麻醉科专科护士岗位胜任力各级评价指标及权重.结果 麻醉科专科护士岗位胜任力评价指标体系包含专业知识、专业技术、专业能力、管理能力和个人特质5项一级指标和38项二级指标.两轮函询专家积极系数分别为89.47％和94.12％,专家权威系数分别为0.865和0.889,肯德尔协调系数分别为0.182、0.237(均P＜0.01).结论 构建的麻醉科专科护士岗位胜任力评价指标体系,可作为麻醉科专科护士岗位胜任力水平的测评工具,为麻醉科专科护士培训、考核及任用提供参考.     

心脏介入诊疗专科专职管理与护理

目的探讨心血管专科护士对心脏介入诊疗术施行专职管理与程序化护理的效用性。方法专科病房配备1名护士专职管理消毒隔离和专科药物、仪器设备,介入导管材料及职业防护,并实施专职护理。结果实施后与实施前相比,总诊疗量、经济效益显著增长,并发症、诊疗时间显著缩短。结论实施专科专职管理与护理能提高护理工作的预见性,及时防治并发症,提升专科护理及管理质量。     

介入专科护士核心能力评价指标的初步构建

目的初步构建介入专科护士核心能力评价指标,旨在为介入专科护士的培养、考核、评价与管理提供参考。方法采用德尔菲法对18名专家进行2轮函询,并确定介入专科护士核心能力指标及权重。结果2轮函询专家的积极性分别为100%、88.89%;专家的权威系数为0.90;一、二、三级指标的协调系数分别为0.357、0.401、0.436(均P0.01)。最终确立的评价指标包括理论知识能力、实践操作能力、批判性思维能力、人际交往能力、护理临床管理能力、科研学习能力、指导能力7项一级指标,23项二级指标,56项三级指标。结论介入专科护士核心能力评价指标的专家意见集中,可信度高,可为介入专科护士的培养、考核、评价与管理提供参考。     

医院质量与安全评价指导下的血液专科病房护理岗位安全管理

目的探讨在医院质量与安全评价指导下血液专科病房护理岗位安全管理的实施效果。方法在对医院质量与安全评价标准充分解读及指导下,血液专科病房着重护理岗位安全管理,重点落实岗位设置、培训及管理各项措施。结果实施1年后,患者满意度、护士满意度及一级护理评分较实施前显著提高(均P0.05)。结论通过医院质量与安全评价活动的开展,指导血液专科构建护理安全文化,促进内涵建设,保障了患者护理安全,提升了专科护理质量。     

临床护士对奖金分配的满意度及需求调查

目的了解临床护士对奖金分配方案的满意度及对绩效考核的需求,为制定合理的绩效分配方案提供参考。方法采用分层抽样和随机抽样的方法抽取138名临床护士,进行奖金分配方案满意度及需求调查。结果临床护士对奖金分配的满意度仅15.2%~31.2%;42.8%的护士愿意按绩效考核分配奖金;护士认为绩效考核分配应结合工作量、职称、年资、班次、岗位、工作质量等指标,支持率为58.7%~93.5%。结论为稳定护理队伍,调动护士工作积极性,护理管理者应建立公平合理的奖金绩效分配方案。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.